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Case of the Week #187

Clinical History

The patient is a 53 year old man with diabetes, on dialysis for end stage renal disease,
with an enhancing mass on his left kidney discovered by abdominal CT scan.

Micro images:

Smooth muscle actin CD31

What is your diagnosis?

Diagnosis:

Glomus tumor of the kidney

Discussion:

Glomus tumors are composed of modified perivascular smooth muscle cells. They have a spectrum of histologic types, including glomangioma (more vascular) and glomangiomyoma (with elongated smooth muscle cells). They are most common in the distal extremities, and are very rare in the kidney.

Microscopically, they are well circumscribed tumors, composed of sheets and nests of round, somewhat cohesive cells, that may appear epithelioid. The histologic appearance varies based on the ratio of vascular to glomus cells, the amount and composition of stroma, and the state of differentiation of the glomus cells.

Tumor cells are immunoreactive for smooth muscle actin (as in this case) and vimentin. They are negative for endothelial, epithelial, melanocytic and neuroendocrine markers, although some markers may stain entrapped renal epithelium, and vascular markers (including CD31) stain surrounding vessels.

Glomus tumors typically have benign behavior, and excision is curative.